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RENAL CELL CARCINOMA IN 2018

Radical shifts in the first-line management of metastatic renal cell carcinoma

In 2018, the results of multiple phase III trials in metastatic renal cell carcinoma (mRCC) were presented. A phase III noninferiority trial demonstrated the importance of careful patient selection before cytoreductive nephrectomy. Additionally, three randomized phase III trials demonstrated the superiority of combination therapy with an immune-checkpoint inhibitor backbone versus sunitinib in patients with treatment-naive mRCC.

Key advances

  • Careful patient selection is critical for patients with metastatic renal cell carcinoma (mRCC) being considered for cytoreductive nephrectomy and should be discouraged in patients with poor-risk mRCC who have a high burden of extrarenal disease4.

  • A phase III trial comparing ipilimumab and nivolumab versus sunitinib in first-line intermediate-risk and poor-risk mRCC demonstrated an overall survival benefit for patients receiving ipilimumab and nivolumab6.

  • Multiple phase III trials in treatment-naive mRCC demonstrated that the combination of immune-checkpoint inhibitors with VEGF-targeted agents is superior to VEGF-targeted therapy alone7,9.

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Correspondence to Brian I. Rini.

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M.C.O. has received fees as a consultant of Bristol-Myers Squibb, Exelixis, Eisai and Pfizer. B.I.R. has received fees as a consultant of Bristol-Myers Squibb, Merck and Pfizer.

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Ornstein, M.C., Rini, B.I. Radical shifts in the first-line management of metastatic renal cell carcinoma. Nat Rev Clin Oncol 16, 71–72 (2019). https://doi.org/10.1038/s41571-018-0146-4

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